范继红，胡桃红，贺威，靳志涛，张铮，丁力平，高国杰，杨军珂，王承竹



肾功能正常或轻度损害的急性冠状动脉综合征患者经皮冠状动脉介入治疗术后发生对比剂肾病的危险因素分析

范继红，胡桃红，贺威，靳志涛，张铮，丁力平，高国杰，杨军珂，王承竹

摘要

关键词对比剂肾病；急性冠状动脉综合征； 冠状血管造影术 ；危险因素

作者单位：030001 山西省太原市，山西医科大学第二临床医学院（范继红）；中国人民解放军第二炮兵总医院 心血管内科（胡桃红、靳志涛、张铮、丁力平、 高国杰、 杨军珂、 王承竹）；苏州大学第一临床医学院 心血管内科（贺威）

Risk Factor Analysis for Contrast-induced Nephropathy in Patients of Acute Coronary Syndrome With Normal or Slightly Impaired Renal Function After Percutaneous Coronary Intervention

FAN Ji-hong, HU Tao-hong, HE Wei, JIN Zhi-tao, ZHANG Zheng, DING Li-ping, GAO Guo-jie, YANG Jun-ke, WANG Cheng-zhu. The Second Clinical College of Shanxi Medical University, Taiyuan (030001), Shanxi, China
Corresponding Author: HU Tao-hong, Email: hutaohong2010@163.com

Abstract

Objective: To evaluate the risk factors for contrast-induced nephropathy (CIN) in patients of acute coronary syndrome (ACS) with normal or slightly impaired renal function after percutaneous coronary intervention (PCI).

Methods: A total of 254 consecutive ACS patients with normal or slightly impaired renal function received PCI in the Second Artillery General Hospital from 2013-06 to 2015-06 were retrospectively studied. All patients had eGRF≥60 ml (min•1.73 m2) and they were divided into 2 groups: CIN group, the patients with serum creatinine increased by 0.5mg/dl (44.2 μmol/L) or elevated to 25% higher than the baseline, n=23; Non-CIN group, n=231. The basic condition with laboratory tests, operative indexes were recorded and eGRF value were calculated in all patients.

Results: There were 9% (23/254) patients suffered from CIN after PCI. Multivariate regression analysis indicated that emergent PCI (OR=0.370, 95% CI 0.060-2.297), increased plasma level of NT-proBNP (OR=4.209, 95% CI 1.202-14.742) and without pre-operative aspirin administration (OR=7.950, 95% CI 1.108-57.034) were the clinical risk factors for post-operative CIN occurrence.

Conclusion: Emergent PCI, higher plasma level of NT-proBNP and no pre-operative aspirin administration were the riskfactors for CIN occurrence in ACS patients with normal or slightly impaired renal function after PCI.

Key words Contrast induced nephropathy; Acute coronary syndrome; Angiography; Risk factor

(Chinese Circulation Journal, 2016,31:31.)

急性冠状动脉综合征（ACS）是心血管系统的急重症，经皮冠状动脉介入治疗（PCI）是ACS患者明确诊断和血运重建的重要手段。在行PCI的患者中，对比剂肾病已成为不容忽视的严重并发症[1]，与肾功能衰竭发病率增高、近远期死亡率增加等临床不良事件密切相关[2]。既往文献指出，ACS患者是对比剂肾病高发人群，发生率高于其他人群3倍[3，4]，糖尿病及肾功能不全可使对比剂肾病发生率升高到50%[5，6]。而相关研究表明，术前肌酐正常或轻度增高[肾小球滤过率（eGFR）≥ 60 ml/（min·1.73 m2）]的患者行PCI术后对比剂肾病发生率仍可达13.9%，且发生对比剂肾病后死亡率明显增加（5.2% vs 0.7%，P<0.01），其他临床不良事件（肾脏替代治疗、再发心肌梗死等）也显著增加[7]。目前，对对比剂肾病有明确治疗作用的药物证据尚不充分，且肾功能正常或轻度损害患者通常被认为是对比剂肾病的低风险人群较少受到关注；因此，在操作之前辨别对比剂肾病高危人群并制定预防性措施是必要的。本研究旨在探讨eGFR≥ 60 ml/（min·1.73 m2）的ACS患者对比剂肾病的发生率及危险因素，为临床工作提供更大的帮助。

1　资料与方法

对象：连续入选2013-06至2015-06因ACS（包括急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死、不稳定性心绞痛）于中国人民解放军第二炮兵总医院心血管内科行PCI且eGFR≥ 60 ml/ （min·1.73 m2）的患者共254例。排除标准：严重心、肾功能不全，肾移植、透析，甲状腺功能异常或既往有甲状腺疾病者，对比剂过敏，7天内应用过对比剂，正在应用保肾或肾损害药物。……